Review: liquid nicotine toxicity2.5 out of 5 stars
Liquid Nicotine Toxicity. Kim JW, Baum CR. Pediatr Emer Care 2015;31:517-524.
Abstract
This review of liquid nicotine toxicity is part of the continuing medical education series in Pediatric Emergency Care.
While there are a few good clinical nuggets buried in this review, they are surrounded by so many distracting and unnecessary epidemiological facts that the whole paper — though relatively short — is a chore to read. In addition, some of the “facts” are wrong. For example::
A study found that the proportion of calls that poison control centers received regarding e-cigarettes and cigare...Source: The Poison Review - July 30, 2015 Category: ToxicologyAuthors: Leon Tags: Medical e-cigarettes electronic cigarettes liquid nicotine toxicity Source Type: news

Venlafaxine abuse2.5 out of 5 stars
Venlafaxine as the ‘baby ecstasy’? Literature overview and analysis of web-based misusers’ experiences. Francesconi G et al. Hum Psychopharmacol Clin Exp 2015 Jul;30:255-261.
Abstract
In 2003, Sattar et al published a case report of venlafaxine abuse in a 38-year-old man. The patient had been prescribed 225-mg extended-release venlafaxine daily. He found that increasing his dose by 50% — to 337.5-mg per day — initially produced a “sudden, amphetamine-like ‘high'” that he did not re-experience even after increasing the dose to 450-mg.
He subsequently discovered ...Source: The Poison Review - July 30, 2015 Category: ToxicologyAuthors: Leon Tags: Medical abuse effexor overdose venlafaxine Source Type: news

Case series: anxiety and agitation following exposure to the synthetic cannabinoid ADB-PINACA3 out of 5 stars
A Common Source Outbreak of Severe Delirium Associated with Exposure to the Novel Synthetic Cannabinoid ADB-PINACA. Schwartz MD et al. J Emerg Med 2015 May;48:573-80.
Abstract
As noted in a recent survey of synthetic cannabinoid exposures in the New England Journal of Medicine, the synthetic cannabinoid (SC) ADB-PINACA was associated with outbreaks in August and September 2013, both in Brunswick GA (22 cases) and Denver CO (> 220 exposures).
This paper reports on 7 cases from the outbreak in Georgia. All patients tested positive for ADB-PINACA or its metabolic ADB-PINACA-5-Pentoic Acid in plasma a...Source: The Poison Review - July 29, 2015 Category: ToxicologyAuthors: Leon Tags: Medical ADB-PINACA agitation anxiety black mamba case series crazy clown delirium synthetic cannabinoid Source Type: news

Death after consuming a marijuana edibleThis report describes the investigation by the Colorado Department of Public Health and Environment (CDPHE) into a well-publicized fatality that occurred shortly after recreational marijuana became available in that state.
In March 2014, a 19-year-old man ingested one piece of a marijuana cookie purchased by his 23-year-old friend. (Note: at that time as well as now, the legal age for using marijuana in Colorado was 21.) When he felt no effects after 30-60 minutes, he ingested the remainder of the cookie:
“During the next 2 hours, he reportedly exhibited erratic speech and hostile behaviors. Approximately 3.5 hours a...Source: The Poison Review - July 23, 2015 Category: ToxicologyAuthors: Leon Tags: Medical 11-OH-THC death fatality edible marijuana pot Source Type: news

5F-ADB-PINACA and other extremely potent new synthetic cannabindoids3.5 out of 5 stars
Pharmacology of Indole and Indazole Synthetic Cannabinoid Designer Drugs AB-FUBINACA, ADB-FUBINACA, AB-PINACA, ADB-PINACA, 5F-AB-PINACA, 5F-ADB-PINACA, ADBICA, and 5F-ADBICA. Banister SD et al. ACS Chem Neurosci 2015 July 17 [Epub ahead of print]
Abstract
As TPR noted in a recent post, many recently reported cases of severe toxicity or death associated with exposure to synthetic cannabinoids (SCs) involved relatively new and unfamiliar chemicals such as MAB-CHMINACA, AB-PINACA, and ADB-PINACA.
These new compounds incorporate either an indole or an indazole group, and have structured that can be altered...Source: The Poison Review - July 22, 2015 Category: ToxicologyAuthors: Leon Tags: Medical 5F-ADB-PINACA FUBINACA indazole indole synthetic cannabinoid Source Type: news

Serious toxicity and fatalities from synthetic cannabinoids3.5 out of 5 stars
Synthetic Cannabinoid—Related Illnesses and Deaths. Trecki J et al. N Engl J Med 2015 Jul 9;373:103-107.
Reference
As the authors point out in this interesting article, there has been a recent surge in reports of fatalities and severe toxicity from synthetic cannabinoids (SCs). This is likely from a combination of increased incidence and more diligent surveillance.
The most interesting part of the paper is the Table, that lists recent cases involving severe toxic effects from SCs, including 20 deaths. The specific SCs involved in the fatal cases include MAB-CHMINACA, AB-PINACA, XLR-11, ADB-PINACA, and...Source: The Poison Review - July 20, 2015 Category: ToxicologyAuthors: Leon Tags: Medical death fatality MAB-CHMINACA synthetic cannabinoids Source Type: news

Tox Tunes #99: Casey Jones (Grateful Dead)The critical response to the final 3 performances of the Grateful Dead’s “Fare Thee Well” tour has been decidedly mixed. In the New York Times, Jon Pareles reported that “Even with a handful of the Dead’s inevitable stumbles, the music was strong.”
On the other hand, Greg Kot’s review in the Chicago Tribune was headlined “Grateful Dead pay slack tribute to legacy.”
This time around, as the Times cleverly notes, its “as much about today as yesterday, more hashtags than hash, less Summer of Love than summer of ‘likes.'” Some fans are coming not in psych...Source: The Poison Review - July 5, 2015 Category: ToxicologyAuthors: Leon Tags: Medical casey jones grateful dead tox tunes Source Type: news

Tox Tunes #98: Truckin’ (The Grateful Dead)Surprisingly, “Tox Tunes” has featured only one Grateful Dead song so far. This weekend seemed a good time to catch up, as the remnants of The Dead play their farewell concerts at Soldier Field in Chicago in the biggest festival the Windy City has seen since smaccUS.
There are, of course, a number of drug references in the song, which relates the autobiography of the band through the early 1970s. On January 31, 1970, 19 members of the band and its touring party — including their live-in street chemist and sound engineer Owsley Stanley — were arrested in New Orleans for possession of marijuana:
Sitting and s...Source: The Poison Review - July 3, 2015 Category: ToxicologyAuthors: Leon Tags: Medical grateful dead tox tunes truckin' Source Type: news

Tox Tunes #97: Resurrection Mary (Ian Hunter)Combining Chicago lore, poisons, and a ghost, this is the perfect “Tox Tune” to post the weekend before smaccUS descends on the Windy City.
“Resurrection Mary,” which appeared on Ian Hunter’s 1996 album The Artful Dodger, recounts the famous Chicago ghost story involving about a vanishing hitchhiker who is periodically sited near the Resurrection Cemetery in southwest suburban Justice. Legend has it that the hitchhiker is the ghost of a young girl killed by an automobile in the late 1920s or early 1930s while trying to get away from her boyfriend.
As recounted by Wikipedia:
Since the 1930s,...Source: The Poison Review - June 21, 2015 Category: ToxicologyAuthors: Leon Tags: Medical Chicago ian hunter resurrection mary tox tunes Source Type: news

Looking back: the first FOAMed meeting in the U.S.This photograph, from November 2010, documents what was to my knowledge the first #FOAMed get-together on U.S. soil. Gathered that evening at a tapas restaurant in San Francisco during the “Essentials of EM” conference were (from left to right):
Anton Helman (Emergency Medicine Cases)
Chris Nickson (Life in the Fast Lane)
Scott Weingart (EMCrit)
Michelle Lin (Academic Life in Emergency Medicine)
Leon Gussow (The Poison Review)
It is truly amazing to realize that only four-and-a-half years later, 2000 foamheads from around the world are descending on Chicago for the 3-day festival of life and learning calle...Source: The Poison Review - June 20, 2015 Category: ToxicologyAuthors: Leon Tags: Medical FOAM FOAMed FOAMtox smaccus Source Type: news

Illustrated case report of phenol exposurePhenol
3.5 out of 5 stars
Phenol Toxicity Following Cutaneous Exposure to Creolin®:A Case Report. Vearrier D et al. J Med Toxicol 2015 Jun;11:227-231.
Abstract
This paper is worth looking at for the excellent color photographs of the partial thickness skin burns induced by exposure to Creolin®, which contains carbolic acid (phenol), sodium hydroxide, and isopropanol.
A 9-year-old girl was brought to the emergency department because of respiratory distress and unresponsiveness. Symptoms came on quickly and started within 4 minutes of the mother pouring 8 oz Creolin® over the patients hair in an attempt to get rid of hea...Source: The Poison Review - June 18, 2015 Category: ToxicologyAuthors: Leon Tags: Medical coagulative necrosis creolin phenol surface burn Source Type: news

Case series: 11 hospital workers symptomatic after ingesting “synthetic marijuana” brownies3 out of 5 stars
Cluster of Acute Toxicity from Ingestion of Synthetic Cannabinoid-Laced Brownies. Obafemi AI et al. J Med Toxicol 2015 May 13 [Epub ahead of print]
Abstract
This case series describes 11 patients brought to hospital after inadvertently ingesting brownies laced with the synthetic cannabinoid AM-2201.
All 11 patients were hospital workers who ingested brownies brought to work by a staff member. In each patient, symptoms started within an hour of ingestion and generally resolved within 2 to 4 hours (although two persons felt tired and dizzy for up to 10 hours post-ingestion.) The most common neurological ma...Source: The Poison Review - June 16, 2015 Category: ToxicologyAuthors: Leon Tags: Medical acute toxicity AM-2201 ingestion synthetic cannabinoid Source Type: news

Podcast: Managing the crashing tox patient with ECMOAs I wrote about in a recent column for Emergency Medicine News, extracorporeal membrane oxygenation (ECMO) may be the next big thing in managing the severely ill, crashing overdose patient in whom usual therapy is not working. On the new podcast posted today at the EDECMO website, Steve Aks and I got together over Skype with Joe Bellezzo, Zack Shinar, and Scott Weingart to discuss the potential benefits, as well as the potential risks and complications, involved in using ECMO in the sickest tox patients.
Some of the topics we discuss:
What overdose patients might benefit most from ECMO?
What vascular access is needed fo...Source: The Poison Review - June 16, 2015 Category: ToxicologyAuthors: Leon Tags: Medical ECMO edecmo extracorporeal membrane oxygenation podcast poisoning toxicology Source Type: news

Dramatic recent increase in cases and deaths associated with use of synthetic cannabinoids4 out of 5 stars
Increase in Reported Adverse Health Effects Related to Synthetic Cannabinoid Use —United States, January-May 2015. MMWR 2015 Jun 12;64:618-619.
Full Text
I have to say that this report shocked me some. Although I was aware of an increased number of news reports of incidents related to synthetic cannabinoids, I really had no idea the increased number of cases involving exposures reported to poison centers with major adverse effects and death were so dramatic.
As this report points out:
“Synthetic cannabinoids include various psychoactive chemicals or a mixture of such chemicals that are sprayed ont...Source: The Poison Review - June 13, 2015 Category: ToxicologyAuthors: Leon Tags: Medical CDC national poison data system spice mmwr synthetic cannabinoid Source Type: news

How lipid rescue therapy works: it’s more than just a sinkThis study, from Guy Weinberg’s lab at the University of Illinois, used a rat model of bupivacaine toxicity, along with and computational analysis, to investigate the mechanisms by which lipid rescue therapy (LRT) might act in treating overdose from local anesthetics and other cardiotoxic drugs.
This is a very complex paper, and I have to admit that I found reading through the experimental protocol rough going. However, the authors findings are important and convincing. The results suggest that — as the title of the paper indicates — there are several modalities that provide benefit:
LRT accelerated removal of d...Source: The Poison Review - June 10, 2015 Category: ToxicologyAuthors: Leon Tags: Medical antidote bupivacaine intralipid lipid emulsion lipid rescue therapy local anesthetic triglyceride Source Type: news

“Rick and Jerry”: a saluteAt the Emergency Physicians Monthly website, Mel Herbert posted a lovely tribute to Rick Bukata and Jerry Hoffman as they pass off the lead anchoring duties on Emergency Medicine Abstracts to a new generation of medical educators.
I think Mel’s piece captures the impact and influence of the Abstracts perfectly. When I started listening to the monthly tapes in the mid-1980s, I found them to be a revelation. Certainly, a critical approach to analyzing medical literature was not taught at all in medical school, although it is certainly one of the most important skills a physician can have. Other packages that tried ...Source: The Poison Review - June 8, 2015 Category: ToxicologyAuthors: Leon Tags: Medical emergency medicine abstracts jerry hoffman rick bukata Source Type: news

Tox Tunes #96: Champagne and Reefer (Rolling Stones and Buddy Guy)This is a great version of Muddy Waters’ song “Champagne and Reefer” by the Stones and Buddy Guy. Those who will be in Chicago for SMACCus may want to stop into Buddy Guy’s Legends, a club that is virtually downtown and where Buddy himself sometimes shows up to play.
Related post:
Tox Tunes #32: Champagne and Reefer (Muddy Waters) (Source: The Poison Review)Source: The Poison Review - June 8, 2015 Category: ToxicologyAuthors: Leon Tags: Medical Source Type: news

Tox Tunes #96: Champagne and Reefer (rolling Sontes and Buddy Guy)This is a great version of Muddy Waters’ song “Champagne and Reefer” by the Stones and Buddy Guy. Those who will be in Chicago for SMACCus may want to stop into Buddy Guy’s Legends, a club that is virtually downtown and where Buddy himself sometimes shows up to play.
Related post:
Tox Tunes #32: Champagne and Reefer (Muddy Waters) (Source: The Poison Review)Source: The Poison Review - June 8, 2015 Category: ToxicologyAuthors: Leon Tags: Medical Source Type: news

Episode #9: TPR Podcast on hemodialysis in poisoningsEpisode 9: EXTRIP Review
Written by Theresa Kim, MD
Outline
EXTRIP Guideline Methodology
Methanol
Theophylline
Lithium
Acetaminophen
EXTRIP Guideline Methodology
Extracorporeal treatments (ie. hemodialysis, hemoperfusion) are commonly used in poisonings despite lack of formal human trials
Goal of the EXTRIP workgroup was to form an international collaboration among experts from nephrology, toxicology, critical care, pharmacology, and over 30 professional societies to form consensus recommendations and suggestions based on available research and expert opinion
Clinical evidence ranked using GRADE syst...Source: The Poison Review - June 1, 2015 Category: ToxicologyAuthors: LeonThe Poison Review Tags: Podcast Source Type: news

Tox Tunes #95: Dead Flowers (Townes Van Zandt)The Rolling Stones’ original version of “Dead Flowers” was on their 1971 Sticky Fingers album, along with a number of other songs definitely or possibly about drugs, including “Brown Sugar,” “Moonlight Mile,” and “Sister Morphine.”
The song was written in the late 1960s, when Keith Richards was hanging out with the country-rock musician Gram Parsons. Although fans debate whether or not the term “dead flowers” refers to poppies, the other reference to heroin is unmistakable:
I’ll be in my basement room
With a needle and a spoon
I much prefer Townes Van ...Source: The Poison Review - June 1, 2015 Category: ToxicologyAuthors: Leon Tags: Medical dead flowers rolling stones townes van zandt tox tunes Source Type: news

Keys to the safe use of naloxone4 out of 5 stars
Reducing the harm of opioid overdose with the safe use of naloxone: a pharmacologic review. Kim HK, Nelson LS. Expert Opin Drug Saf 2015 Apr 12:1-10 [Epub ahead of print]
Abstract
This review of naloxone comes down strongly on the side of “less is more,” and argues that when reversing opiate overdose a starting dose of 2 mg — or even 0.4 mg — is unnecessary and risks precipitating acute opiate withdrawal syndrome (OWS).
Although some clinicians will not agree with all the authors’ opinions, they are well thought out and worth considering. Some key points:
Naloxone’s duration o...Source: The Poison Review - May 28, 2015 Category: ToxicologyAuthors: Leon Tags: Medical antidote naloxone narcan opiate overdose opioid intoxication Source Type: news

Unlabeled amphetamine isomer in sports supplement “probably” caused hemorrhagic stroke3.5 out of 5 stars
Hemorrhagic Stroke Probably Caused by Exercise Combined With a Sports Supplement Containing β-Methylphenylethylamine (BMPEA): A Case Report. Cohen P et al. Ann Intern Med 2015 May 12 [Epub ahead of print]
Reference
Last month, the FDA sent letters to 5 companies that manufacture so-called “dietary” or “sports” supplements, warning them that their products were mislabeled because they contained an unlisted ingredient.
That ingredient, β-methylphenylethylamine (BMPEA), is an isomer of amphetamine. Although the effects of BMPEA in humans have not been well studied, it has been ...Source: The Poison Review - May 22, 2015 Category: ToxicologyAuthors: Leon Tags: Medical amphetamine beta-methylphenylethylamine BMPEA dietary supplement hemorrhagic stroke sports supplement Source Type: news

ED sedation with droperidol is relatively safe and effectiveThis study has shown that droperidol is relatively safe and effective for the management of violent and aggressive patients in the ED and that there was no increased risk of QT prolongation and torsades de points according to a large cohort of cases.”
The “Editor’s Capsule Summary” that accompanies the article is even more emphatic*:
How this is relevant to clinical practice
Droperidol is safe even with the high doses used in this study.
The authors note that the study does not rule out that droperidol may be associated with rare cases of torsades. But the agitated, delirious ED patient may be a dan...Source: The Poison Review - May 20, 2015 Category: ToxicologyAuthors: Leon Tags: Best of TPR Medical black box warning droperidol FDA food and drug administration QT prolongation torsades de pointes Source Type: news

Lipid rescue therapy and ECMO in the poisoned patient — can they be used together?3 out of 5 stars
What are the adverse effects associated with the combined use of intravenous lipid emulsion and extracorporeal membrane oxygenation in the poisoned patient? Lee HM et al. Clin Toxicol 2015;53:145-150.
Abstract
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is often used in the neonatal and pediatric intensive care units on children who are also receiving intravenous lipid emulsion (LE) for nutritional support. Complications reported in patients receiving both interventions include lipid agglutination, clogging, occurrence of blood clots, and cracking of parts of the ECMO circuit.
There is inc...Source: The Poison Review - May 16, 2015 Category: ToxicologyAuthors: Leon Tags: Medical antidote ECMO extracorporeal membrane oxygenation intralipid lipid emulsion lipid rescue therapy poisoned patient Source Type: news

Severe reactions to “Spice” on rise, some associated with drug MAB-CHMINACAAB-CHMINACA
3 out of 5 stars
In vitro and in vivo human metabolism of the synthetic cannabinoid AB-CHMINACA Erratico C et al. Drug Test Analysis 2015 Apr 12 [Epub ahead of print]
Abstract
The New York Times reported today on the recent dramatic increase in emergency department visits related to use of synthetic cannabinoids (call colloquially, but somewhat inaccurately, “Spice”). This phenomenon has been seen in many states, especially Mississippi, Pennsylvania, and New York.
According to reports, patients often present with agitation, delirium, and hallucinations. Medical complications have included rhabdo...Source: The Poison Review - April 25, 2015 Category: ToxicologyAuthors: Leon Tags: Medical CHMINACA spice synthetic cannabinoid Source Type: news

Even Dr. Oz can’t rebut John OliverDr. Oz’s rebuttal yesterday to the letter from ten self-described “distinguished physicians” who demanded that Columbia Medical School cancel his faculty appointment was absolutely brilliant — recasting the narrative from the selling of snake oil to standing up for free speech and against the juggernaut agricultural-industrial complex.
But there’s no rebuttal to John Oliver.
See also Michael Specter’s New Yorker blog post on this issue, as well as his superb profile of Dr. Oz in the magazine. (Source: The Poison Review)Source: The Poison Review - April 24, 2015 Category: ToxicologyAuthors: Leon Tags: Medical columbia dr. oz john oliver Source Type: news

Poisonous birds: what’s new3 out of 5 stars
Poisonous birds: A timely review. Ligabue-Braun R, Carlini CR. Toxicon 2015 Mar 31;99:102-108.
Abstract
It was just over two decades ago that Dumbacher et al published their landmark paper describing the presence of the alkaloid batrachotoxin (BTX, “frog poison”) in the skin and feathers of three species of Pitohui bird in New Guinea. This toxin binds to voltage-gated sodium channels maintaining them in the open position. This action causes depolarization of nerves and myocardial cells. This may serve the bird by acting as a “chemical defense” against large predators, or as a ...Source: The Poison Review - April 21, 2015 Category: ToxicologyAuthors: Leon Tags: Medical batrachotoxin bird catharidin coturnism hoopoe pitohui bird poison quail rhabdomyolysis spur-winged goose toxicity Source Type: news

27 fatalities from laboratory-confirmed exposure to PMMA (“Dr. Death”)4 out of 5 stars
Deaths from exposure to paramethoxymethamphetamine in Alberta and British Columbia, Canada: a case series. Nicol JJE et al. CMAJ Open. 2015 Jan 13;3(1):E83-9
Full Text
From June 2011 through April 2012, 27 deaths in the Canadian provinces of Albert and British Columbia were attributed to the hallucinogenic stimulant para-methoxy-N-methylamphetamine (PMMA) as the primary toxic agent based postmortem examination and toxicology results. PMMA is so dangerous that it is known on the street as “Death” and “Dr. Death.” This paper constitutes a retrospective review of those cases based on r...Source: The Poison Review - April 18, 2015 Category: ToxicologyAuthors: Leon Tags: Best of TPR Medical alberta bath salt british columbia canada death dr. death ecstasy fatality hyperthermia mdma PMMA serotonin syndrome synthetic designer drug Source Type: news

Risk of completed suicide after initial hospitalization for deliberate overdose3.5 out of 5 stars
Risk of Suicide Following Deliberate Self-poisoning. Finkelstein Y et al. JAMA Psychiatry 2015 Apr 1 [Epub ahead of print]
Abstract
The authors primary objective was to determine the risk of subsequent successful suicide in patients discharged from hospital after a first suicide attempt. They used multiple healthcare databases to identify patients hospitalized for first suicide attempt in Ontario, Canada from April 2002 through December 2010. Subjects identified were followed through the end of 2011. For each subject a control patient without history of self-poisoningt was selected, matched for age, gend...Source: The Poison Review - April 11, 2015 Category: ToxicologyAuthors: Leon Tags: Medical overdose risk self-poisoning suicide Source Type: news

Less is more: fatal C. difficile colitis after empiric antibioticsAspiration pneumonitis
4 out of 5 stars
Antibiotics “Just-In-Case” in a Patient With Aspiration Pneumonitis. Joundi RA et al. JAMA Intern Med 2015 Apr 1;175:489-490
Reference
This very brief but very important case report contains more key points than most papers 10 times as long. The case describes a 50-year-old man with cerebral palsy and a known seizure disorder who had several witnessed tonic-clonic seizure episodes treated with a benzodiazepine. Subsequent chest x-ray revealed multiple bibasilar opacities consistent with aspiration.
The patient was started on piperacillin-tazobactam. Although he showed si...Source: The Poison Review - April 9, 2015 Category: ToxicologyAuthors: Leon Tags: Medical adverse drug event aspiration pneumonia aspiration pneumonitis clostridium difficile colitis Source Type: news

Factors associated with emergency department opioid-related adverse drug eventsThis study has a number of limitations, which the authors discuss candidly. For example, the study design would miss capturing a patient who received an opioid in the emergency department, was admitted, and died from respiratory depression on the floor. Nevertheless, this is a valuable reminder of the patient, provider, and systems factors that should raise red flags of caution when administering opioids in the emergency department. Worth reading.
(Source: The Poison Review)Source: The Poison Review - April 8, 2015 Category: ToxicologyAuthors: Leon Tags: Medical adverse drug events dilaudid emergency department hydromorphone opiates opioids Source Type: news

“Flakka”: one of the most bizarre drugs yetSouth Florida has recently seen a number of cases associated (at least by history) by exposure to a street drug called “Flakka”:
In Lake Worth, a naked man brandishing a handgun stood on the roof of an apartment building, shouting “I feel delusional, and I’m hallucinating.”
In Fort Lauderdale, a man tried to kick in the door of the local police station because he thought he was being chased by automobile seeking to do him harm.
And 2 weeks ago, also in Fort Lauderdale, a man impaled himself on a spiked fence around a police station apparently in thrall to a paranoid delusion:
It is no wonder ...Source: The Poison Review - April 4, 2015 Category: ToxicologyAuthors: Leon Tags: Medical alpha-PVP bath salts flakka gravel Source Type: news

Do we know the best treatment for jellyfish stings?2.5 out of 5 stars
What is the Most Effective Treatment for Relieving the Pain of a Jellyfish Sting? Ostermayer DG, Koyfman A. Ann Emerg Med 2015 Apr;65:432-433.
Reference
This short article manages to pack a maximum amount of confusion into a very small space. The authors perform a literature search to find evidence that would answer their title question, but come up with only a single relevant randomized controlled trial that included exclusively stings from a specific jellyfish, the bluebottle (Physalia).
That study involved 96 subjects with apparent bluebottle stings, and compared immersion of the affected body part...Source: The Poison Review - April 2, 2015 Category: ToxicologyAuthors: Leon Tags: Medical bluebottle jellyfish peeing physalia portuguese man of war sting treatment urine vinegar Source Type: news

3 die in Rochester NY after smoking cocaine/fentanyl combinationSeveral days ago, WHEC NBC news in Rochester NY reported that in the previous week at least 3 people in the area died after smoking a mixture of cocaine and fentanyl. There may have been as many as 4 additional recent deaths associated with this combination.
Late last year, there were 3 similar deaths in North Carolina.
HT: @VPharmER for the heads-up on this story. (Source: The Poison Review)Source: The Poison Review - April 1, 2015 Category: ToxicologyAuthors: Leon Tags: Medical cocaine death fatality fentanyl rochester NY Source Type: news

ACEP Toxicology Section Antidote App (free)This simple but very useful app, from the Toxicology Section of the American College of Emergency Physicians, provides basic information about uses and dosing of basic antidotes used in toxicology. Version 1.1 covers approximately 50 different antidotes from A (acetylcysteine) to T (thiamine).
Of course, clinical judgment is still required when considering these treatments, and most situations requiring use of the antidotes listed would justify consultation with a poison center. For example, one of the potential indications listed for hyperbaric oxygen (HBO) therapy in carbon monoxide (CO) poisoning is myocardial ischemia....Source: The Poison Review - March 27, 2015 Category: ToxicologyAuthors: Leon Tags: Medical ACEP american college of emergency physicians android antidotes app iOS Source Type: news

Review: 23 patients with laboratory-confirmed MDPV exposureMethylenedioxypyrovalerone (MDPV)
3.5 out of 5 stars
Acute Methylenedioxypyrovalerone Toxicity. Fruberg BA et al. J Med Toxicol 2014 Dec 3 [Epub ahead of print]
Abstract
This is an impressive paper, but for reasons the authors thoroughly discuss in their limitations sections, there is somewhat less here than meets the eye.
The authors retrospectively reviewed patients seen over a 2-year period at 10 different hospitals who were entered into the ToxIC Registry and coded under a term consistent with “bath salt” exposure. Cases were eligible for the study if they had blood and/or urine laboratory confirmation p...Source: The Poison Review - March 25, 2015 Category: ToxicologyAuthors: Leon Tags: Medical bath salts MDPV methylenedioxyphyrovalerone ToxIC registry Source Type: news

Tox Tunes #94: Cocaine Blues (David Bromberg)Along comes Sally with her nose all tore
The doctor says she can’t sniff no more
He says that cocaine’s for horses, it’s not for men
He says it’s gonna kill me but he don’t say when
During the American folk music revival that started in the 1930s and continued into the 1960s and 70s, many musicians rediscovered the rich vein of drug themes that ran through the history of blues and country songs. I first heard Luke Jordan’s “Cocaine Blues” through David Bromberg’s excellent cover version.
Jordan (1882-1952) made several recordings for Victor Records in Charlotte NC and ...Source: The Poison Review - March 23, 2015 Category: ToxicologyAuthors: Leon Tags: Medical cocaine blues david bromberg luke jordan tox tunes Source Type: news

Keef Kat, Boddahfinger, and other marijuana edibles — how should they be regulated3 out of 5 stars
Half-Baked — The Retail Promotion of Marijuana Edibles. MacCoun RF, Mello MM. N Engl J Med 2015 Mar 12;372:989-991.
Full Text
This Perspective piece — from authors at the Stanford Schools of Law and Medicine — discusses problems raised by the increasing availability of marijuana edibles in some states. Often, these products are manufactured in forms that are enticing to children (such as cookies, candy bars, and gummy bears) and packaged to look like familiar consumer products. It have written about this problem previously in several columns for Emergency Medicine News — to read them, click here...Source: The Poison Review - March 20, 2015 Category: ToxicologyAuthors: Leon Tags: Medical FDA food and drug administration marijuana edibles schedule I drug THC Source Type: news

Protonix (pantoprazole) can cause a false positive urine screening test for THC3.5 out of 5 stars
13-Year-Old Girl With Recurrent, Episodic, Persistent Vomiting: Out of the Pot and Into the Fire. Felton D et al. Pediatrics 2015 Mar 2 [Epub ahead of print]
Abstract
The package insert for Protonix (pantoprazole) states:
There have been reports of false positive urine screen tests for tetrahydrocannabinol (THC) in patients receiving protein pump inhibitors.
The source of these reports have not been clear, and no cases have previously been reported in the literature. This paper describes a 13-year-old girl who presented to hospital with an episode of recurrent cyclic vomiting syndrome, who was diagnose...Source: The Poison Review - March 6, 2015 Category: ToxicologyAuthors: Leon Tags: Medical cannabis false-positive marijuana pantoprazole protonix THC urine drug screen Source Type: news

Intravenous lipid emulsion in oral overdoses: what is the optimal dosing?This article is an attempt to arrive at a rational dosing schedule for LE in oral overdoses. The authors consider a number of factors:
Very high doses of lipid emulsion have been associated with adverse effects, including acute respiratory distress syndrome
The FDA recommends a maximum dose of 12.5 mL/kg/day when LE is used for nutritional support
The antidotal action of LE may depend on both the “lipid sink” effect and direct cardiac inotropy
Both of the above effects require creation of a moderately lipemic plasma
Combining these considerations with pharmacologic calculations, the authors make the followi...Source: The Poison Review - March 5, 2015 Category: ToxicologyAuthors: Leon Tags: Medical dosing intralipid lipid emulsion lipid rescue therapy Source Type: news

Is lipid emulsion therapy effective in calcium-channel-blocker and beta-blocker overdose?2 out of 5 stars
Role of intravenous lipid emulsions in the management of calcium channel blocker and β-blocker overdose: 3 years experience of a university hospital. Sebe A et al. Postgrad Med 2015 Feb;127:119-124.
Abstract
The authors of this study, from Cukurova University School of Medicine in Turkey, retrospectively reviewed patients admitted to their hospital who were treated with lipid rescue therapy (LRT) for refractory hypotension, heart block, or cardiac arrest following overdose from a calcium-channel-blocker (CCB) or a beta-blocker (BB).
They identified 15 patients(9 CCB, 6 BB.) There were two cardiac arre...Source: The Poison Review - February 28, 2015 Category: ToxicologyAuthors: Leon Tags: Medical beta blocker overdose calcium channel blocker overdose intralipid lipid emulsion lipid rescue therapy Source Type: news

Tox on the web: 12 students hospitalized at Wesleyan College after “Molly” overdoseFour students arrested at Wesleyan College after “Molly” overdoses: Last weekend a dozen students and visitors at Wesleyan University in Middletown, Connecticut were hospitalized after apparently ingesting a drug or drugs labelled as “Molly.” Two victims were in critical condition and were medevacked to Hartford Hospital, the only Level 1 Trauma Center in the region. By mid-week, these two patients were still in hospital but reported to be improving. Four students have been arrested in connection with this incident.
As @forensictoxguy pointed out on his blog “The Dose Makes The Poison,̶...Source: The Poison Review - February 27, 2015 Category: ToxicologyAuthors: Leon Tags: Medical activated charcoal cleanse designer drug detox guy weinberg intralipid lipid rescue therapy mdma molly tox talk wesleyan Source Type: news